Provider Demographics
NPI:1417950650
Name:KANSAS SPINE & SPECIALTY HOSPITAL, L.L.C.
Entity Type:Organization
Organization Name:KANSAS SPINE & SPECIALTY HOSPITAL, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER AND AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:BALDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-234-5954
Mailing Address - Street 1:3333 N WEBB RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-8123
Mailing Address - Country:US
Mailing Address - Phone:316-462-5000
Mailing Address - Fax:316-462-5268
Practice Address - Street 1:3333 N WEBB RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-8123
Practice Address - Country:US
Practice Address - Phone:316-462-5000
Practice Address - Fax:316-462-5268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH087012282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200257840AMedicaid
KS170196Medicare Oscar/Certification